The Significance of Skin Oedema in Locally Advanced Breast Cancer and Its Response to Neoadjuvant Chemotherapy

The prognostic impact of skin oedema in the setting of locally advanced breast cancer, the extent to which this responds to neoadjuvant chemotherapy [NACT], and whether the persistence of oedema represents residual cancer are not known. A prospective study was conducted in the Department of General Surgery, PGIMER, Chandigarh, between 1 August 2017 and 31 July 2018. Locally advanced breast cancer patients who had skin oedema on clinical examination and who completed NACT were included. A punch biopsy was taken from the site of maximum oedema pre-NACT. The resolution of skin changes-oedema/ulceration post-NACT-and skin involvement by histopathology of the mastectomy specimen were analysed. All 29 patients had skin oedema to start with, and 4/29 (13.8%) had skin ulceration. Ten out of 29 (34.5%) patients had skin involvement demonstrable on histopathology pre-NACT. The skin oedema persisted in 26/29 (89.7%) post-NACT, and ulceration persisted in 3/4 (75%). On histopathology of the mastectomy specimen, skin involvement was demonstrable only in 4 patients (13.8%)-3 direct skin infiltration by tumour, 1 dermal lymphatic embolus. Skin oedema clinically persisted even in 4 patients who had a pathological complete response. While most patients have persistence of skin oedema post-NACT, this does not necessarily translate into an actual pathological skin involvement.